Provider Demographics
NPI:1881720852
Name:CRIMSON HOME CARE LLC
Entity type:Organization
Organization Name:CRIMSON HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS MCCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-347-1122
Mailing Address - Street 1:1801 N TRYON ST
Mailing Address - Street 2:B 106
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-2704
Mailing Address - Country:US
Mailing Address - Phone:704-347-1122
Mailing Address - Fax:704-342-4681
Practice Address - Street 1:1801 N TRYON ST
Practice Address - Street 2:B 106
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-2704
Practice Address - Country:US
Practice Address - Phone:704-347-1122
Practice Address - Fax:704-342-4681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3463251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418210Medicaid